1. Information Pyramid UpToDate, Dynamed, FIRSTConsult, ACP PIER
ACP Journal Club
Evidence Based Ophthalmology
Cochrane and other Systematic Reviews (OVID EBMR)
MEDLINE Searches with Clinical Queries
SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), Retrieved from

2. Critically Appraised Content

3. Appraisal Required by User

4. UpToDate
Expert opinion and evidence-based, clinical decision support tool
60,000 pages of original text
7,000 topics in primary care and internal medicine
3,000 expert contributors
Available at large medical institutions, Indian Health Service and VA hospitals
Not available at NSU

5. DynaMed Evidence-based, clinical decision support tool
2,000 up-to-date clinical topic summaries
Information on etiology, directed history & physical findings, differential diagnosis, prognosis, treatment, and prevention
Links to most common ICD-9 Codes
Available at NSU

6. ACP PIER Evidence-based, clinical decision support tool
330 disease modules, 11 videos, and 14,000 pages of medical condition and diagnostic text with graphs and tables
Integrated with STAT!Ref
Available at NSU; Search Stat!Ref

7. FIRSTConsult Evidence-based, clinical decision support tool
1,500 diagnoses, 600 medical conditions, 300 signs & symptoms
Differential diagnosis tool based on chief complaint
Video clips of surgical procedures
Not Available at NSU

8. ACP Journal Club
Expert summaries of original studies and systematic reviews from 150 journals
Value-added abstracts commented on by clinical experts
Commentaries on context, methods, and clinical applications of findings
Available at NSU; Search All Evidence Based Medicine Reviews

9. Evidence Based Ophthalmology
Quarterly journal includes reviews of 24 critically relevant articles from ocular literature
Editorial board comprised of practicing physicians with expertise in epidemiology and clinical trials
Available at NSU; Search NSU

10. Cochrane DSR Systematic reviews conducted by world-wide research group
Limited to studies of prevention and therapeutic interventions
Eyes & Vision Research Group
Available at NSU; Search All Evidence Based Medicine Reviews

11. MEDLINE Searches Limit search results to study type
Double blind randomized controlled trials
Randomized controlled trials
Clinical trials
In OVID, limit by Clinical Queries
Appraise study for validity and relevance

12. Hierarchy of Information Resources
Primary Literature
Original Studies
MEDLINE in Ovid and MD Consult
Secondary Literature
Narrative Reviews
MD Consult and MEDLINE
Systematic Reviews
Cochrane Database of Systematic Reviews; All Evidence Based Medicine Reviews
Evidence-Based Summaries
ACP Journal Club
Evidence-Based Ophthalmology (Journal)
Clinical Decision Support Tools
Dynamed
ACP Pier

13. Primary (Original) Studies
Articles that report results of original research investigations
Conclusions supported by data and reproducible methodology
Good Source: MEDLINE (OVID)

14. Review Articles
Background articles that provide an overview of current research
Integrate recent advances with accepted practice
Summarize – not original works
May mix opinions/bias of the authors with evidence
Good Source: MD Consult

15. Systematic Review
Analyzes data from several primary studies to answer a specific clinical question
Provides search strategies and resources used to locate studies
Includes specific inclusion and exclusion criteria (results in less bias)
Meta-Analysis (subclass) statistically summarizes results of several individual studies
Good Source: Cochrane DSR; All Evidence Based Medicine Reviews

16. Characteristics of Information Retrieval for Patient Care
Using research findings versus conducting research
Retrieving and evaluating information that has direct application to specific patient care problems
Selecting resources that are current, valid, and available at point of care
Developing search strategies that are feasible within time constraints of clinical practice

17. ©Sandra A. Martin
Source: Martin, S. A., Shreeve, S. & Prislin, M. (1999). Development of a longitudinal patient-care oriented informatics curriculum featuring web-based instructional and assessment tools.  Association of American Medical Colleges Annual Meeting.

18. Evidence Based Medicine
The incorporation of the highest quality of information, derived from scientific study, into the context of clinical care
Steps
Defining an evidence-based question
Identifying and critically appraising the best available scientific evidence to answer the question
Deciding on the most appropriate course of action for a given patient

19. Evidence Based Questions
Four basic types of clinical questions:
Diagnosis
Treatment/prevention
Etiology
Prognosis
Certain types of clinical studies constitute highest level of evidence for each type of question

20. Randomized controlled trials are considered the best studies for assessing therapeutic interventions.
Source:  Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

21. Levels of Evidence
Grade the quality of evidence based on the design of the clinical study
Variety of hierarchies in use
Other variables to consider
Factors other than design strengthen validity
Researcher’s reputation
Randomized controlled trials do not always exist to answer some questions
Base decisions on next highest level of evidence
Identify research gaps

22. American Academy of Family Physicians Rating System Level A
Systematic reviews of randomized controlled trials including meta-analyses
Good-quality randomized controlled trials
Level B
Good-quality nonrandomized clinical trials
Systematic reviews not in Level A
Lower-quality randomized controlled trials not in Level A
Other types of study: case control studies, clinical cohort studies, cross sectional studies, retrospective studies, and uncontrolled studies
Level C
Evidence-based consensus statements and expert guidelines

23. Additional Information
Sandra A. Martin, M.L.I.S.
Health Sciences Resource Coordinator
Optometry Subject Librarian
John Vaughan Library Room 305B –